What are my rights when I need to see a specialist doctor – and what if I can’t afford the fee?

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Guardian Australia readers have described facing prohibitive costs, along with limited access, when trying to see medical specialists. Even GPs say referring to other specialists can be difficult to navigate, so it’s little wonder patients are confused about how to access affordable care.
The Consumers Health Forum and the Royal Australian College of General Practitioners say gaps in understanding of the health system contribute to Australians missing out on care or paying too much for it. They have called for greater health literacy, especially around Medicare.
We asked the government and other experts to help clarify some of the most pressing questions patients have, including whether it’s OK to “shop around” for specialists, and how rebates work.
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Can you take your referral to a different specialist than the one named?
A spokesperson for the federal health department confirmed “for Medicare services referrals are not required to be made to a named specialist, and should a referral name a specialist, the patient can choose to see a different specialist within the same specialty”.
The exception is that a named referral is required if someone has chosen to be treated as a private patient in a public hospital’s outpatient service, according to the spokesperson.
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Do you need a specialist referral?
You can book in to see a medical specialist without a referral but Medicare benefits are paid at a lower rate.
The Australian Institute of Health and Welfare explains: “The referral requirement is only mandatory to claim Medicare benefits for specialist and consultant physician attendance items. In the event a patient attends a medical specialist without the referral in place, the patient would be able to claim a Medicare rebate for an ‘other medical practitioner attendance’ item (for example, item 53).”
While item 53 provides a $21 rebate, the rebate for specialist consultations is higher at $148 for an initial consultation and $74 for ongoing patients.
But some specialists require a referral from all patients and refuse appointments without one.
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How do rebates work for specialist consultations?
The Medicare billing to see your GP is based on how long your consultation goes for.
For non-GP specialists the Medicare billing structure is different, with the first consultation more expensive (and also attracting a higher rebate), while subsequent appointments are less expensive (and attract lower rebates). The initial consultation fee can also be charged every time a patient gets a new referral.
The chief executive of the CHF, Dr Elizabeth Deveny, says from a health literacy perspective there is an argument that billing should be more uniform. It can often be confusing for patients if the initial consultation ends up being a matter of minutes and they are charged the higher fee, she says.
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Is a new referral needed every year to see a specialist?
The health department spokesperson says: “Unless otherwise specified by the referring doctor (such as a GP) a referral will cover 12 months from the initial consultation with the referred specialist. Doctors may choose a longer period, or an indefinite referral (with no expiry), where the patient has a condition that requires ongoing treatment.”
When specialists ask for a new referral every year, it can drive up the costs because the higher initial appointment fee can be charged, Deveny says. “If you’ve seen the specialist three times, it’s not a first date, right? And it doesn’t make sense for you to pay at the initial consultation fee when it’s not the initial consultation.
“Your GP can write one that says you can have that [referral] for the rest of your life, and that makes sense if you’ve got a [lifelong] condition.”
A new referral is needed if a new or unrelated condition occurs while on an indefinite referral. Doctor groups say the reason it’s good to go back to GP is that if your health has changed – for example becoming pregnant – that information can be included, according to Deveny.
But she says patients are capable of communicating those changes themselves, and for many patients their health will be unchanged. She says a patient can ask their doctor to write a note to the specialist communicating any changes. Information about a patient’s health can also be uploaded into the digital My Health Record.
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What is the Medicare safety net?
The Medicare safety net supports people who have high out-of-pocket medical costs for services provided outside hospitals.
Once your out-of-pocket medical costs reach a certain threshold, Medicare gives you a higher amount back for each item for the rest of the year. The thresholds amounts are set each year from 1 January.
In 2025, once your out-of-pocket costs for Medicare-subsidised services exceed $576 in the calendar year, Medicare will start reimbursing you the full schedule fee, rather than the usual 85%.
Once out-of-pocket expenses for the calendar year exceed $2,615.50, the extended Medicare safety net kicks in. Medicare will then cover 80% of your out-of-pocket costs for services subsidised under the Medicare benefits schedule. The extended safety net threshold is lower ($834.50) for those with a concession card or with an eligible family tax benefit, if they let Services Australia know so their family’s costs can be counted together.
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How can I find the most affordable specialists?
Specialists can charge whatever they want – but patients have the right to ask for an estimate of fees before the service or treatment and before consenting.
While the federal government’s Medical Costs Finder website is supposed to help patients easily compare specialist fees and out-of-pocket costs, the website has long been criticised for being voluntary for specialists and therefore of little use to patients. Since going live in 2019 just 86 specialists have voluntarily displayed their fee information. This is out of 11,000 specialists across 11 specialties.
As part of its re-election promises the government said it would upgrade the website to display the average fee charged by every eligible specialist across all non-GP specialities.
The health directory Cleanbill has data on GP costs around the country and has started collecting data on non-GP specialists’ fees, with information about dermatologists’ prices now available.
But in the meantime, Deveny says, consumers are reporting “tenfold price differences for the same things”, which she says erodes patient trust.
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What can you do if you are struggling to afford specialist fees?
Deveny says you can ask your GP to refer you to a public hospital clinic, which is free but where the wait times might be longer. You can also ask a specialist to bulk bill you, she says, as doctors often do for their fellow medical practitioners as a professional courtesy.
Read more:

$1,000 for a one-hour appointment: why are fees for Australia’s specialist doctors skyrocketing?